Taking cardiac disease to heart

Dr. Michael Kelberman stopped in the CoreLife Eatery in New Hartford to buy a salad one day and saw about five people inside the health-focused eatery.

At the same time, he said, other area restaurants with less heart-friendly menus had waiting lists for seating.

Kelberman, director of clinical research at CNY Cardiology and director of cardiology at St. Elizabeth Medical Center, sees a simple truth about heart disease in this anecdote. On one hand, research has made great strides in helping people with heart disease to live longer lives and to give them better quality of life through improvements in treatment and greater awareness of health lifestyles.

“Technology continues to rapidly advance. It’s quite remarkable,” he said. “When you think of the size of this community, if people knew the level of things we do, I think they’d be shocked.”

But too few people are listening to lifestyle messages, Kelberman said.

“Over the past 10 years, people in this country have gotten much more unhealthy than they should be, and I think that’s made it harder," he said. "We haven’t made the progress we should have in public health or health awareness. I know it’s talked about a lot, but we haven’t made the progress.”

Two local cardiologists and a national researcher shared their thoughts on major cardiovascular treatment breakthroughs in the last five or 10 years and on what’s ahead.

Cardiologist Dr. Merle Myerson

Director of the preventive cardiology program and lipid clinic at Bassett Medical Center in Cooperstown.

Recent noteworthy breakthroughs:

• “We’re making extremely good progress on percutaneous valve interventions, meaning we can replace a heart valve without open-heart surgery,” she said.

• Ventricular-assist devices also have been life-saving, she said. “If a patient is waiting for a heart transplant, it can actually keep them alive,” Myerson said. In the past, patients might die before an organ became available, she said. Someday, these devices might do more. “They are improving in size and safety and function where they may be what we call destination therapy (in the future), where a patient may simply keep this kind of mechanical assistance device,” she said.

• PCSK9 inhibitors are injectible drugs that can lower LDL, or bad, cholesterol in high-risk patients, such as those who have had a stroke or heart attack and simply can’t get their cholesterol low enough, Myerson said.

Future developments:

• Precision medicine — more individualized therapies based on genetic testing — will become the wave of the future, helping doctors to understand how individuals will respond to different treatments and why some patients have heart attacks and others don’t.

• In the rural population she serves, access to care is a bigger issue than in more populated regions and residents have some unique risk factors, Myerson said. In the future, though, she said she expects to see more awareness and more focus on preventive care instead of waiting for problems to arise.

Jennifer Allport-Anderson

Researcher and director of the cardiovascular metabolic disease therapeutic area for pharmaceutical company Novartis in Cambridge, Massachussetts, whose own research focuses renal disease and heart failure.

Recent noteworthy advancements:

• Entresto, the first new heart failure drug in 25 years — by Novartis — was approved more than two years ago. It helps people whose hearts aren’t pumping well enough. “As we save people from heart attacks … the result is that we’re increasing the number of patients that go into heart failure because now the patient that 20 years ago might have died before they even got to the hospital, they’re surviving, but now their heart is damaged.” People who used to feel like an elephant was sitting on their chest are now taking walks or playing soccer with their grandchildren again, she said.

• Allport-Anderson also cited injectible LDL cholesterol-lower drugs. A Novartis trial found a 15 percent reduction in cardiovascular events and a 25 percent reduction in patients who also had more inflammation, she said. “This is the first time that anyone has tested in a definitive trial this hypothesis of inflammation (as a factor in heart attack risk),” she said.

Future developments:

• Better treatments are needed for peripheral arterial disease, which leaves patients at high risk for wounds on their legs and possibly amputation, Allport-Anderson said. The current care focuses on protecting the heart, but doesn’t do much anything for the progression of the disease. “The one thing that helps these patients is increased exercise, but they’re in so much pain they just can’t do it,” she aid.

• A heart failure drug is needed for the second kind of heart failure in which patients have a stiff heart that can’t fill properly, she said. “For those patients, there is no currently approved drug at all,” Allport-Anderson said.

• New diabetes drugs make patients excrete blood glucose and emerging data is showing that they have a cardiovascular benefit unlike many older diabetes drug that have a negative impact on cardiovascular health, she said. These drugs also help with weight loss, she said. Over the next five to ten years, she expects to see a whole new class of drugs, she said.

Dr. Michael Kelberman

Director of clinical research at CNY Cardiology and director of cardiology at St. Elizabeth Medical Center.

Recent noteworthy breakthroughs:

• Kelberman cited the ability to replace aortic heart valves without surgery. “Even I’m amazed by it, and I’m in the field,” he said. “I would never have dreamt we could replace these heart valves in these older folks who were going to die of it, but couldn’t withstand surgery,” he said.

• Impella devices let surgeons put the heart on temporary bypass while they work on the heart, he said. The machine pumps the blood instead of the heart. “I’ve been in cardiology long enough to watch all these changes happening, and I’m telling you it’s absolutely unbelievable. And yet nobody would know it’s done here,” he said.

Future developments:

• In the future, research will lead to a better understanding of the interplay between cholesterol and other factors the cause plaque build-up in the arteries, Kelberman said. That will help help to make better treatment decisions. “Right now, we treat everybody in much the same way. We need to continue to refine our ability to figure out who will most benefit from what therapies,” he said.

• With greater miniaturization and easier-to-apply therapies, treatment will get safer and easier, he said.

• Lots of research is looking at gene therapy to repair damaged heart muscle, Kelberman said. “I think that’s going to be a big thing in the next five to ten years, using stem cells and things like that. That is a big area of research,” he said.

Contact Amy Neff Roth at 315-792-5166 or follow her on Twitter (@OD_Roth).

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